Guijt et al reported a classification of pituitary apoplexy based on its presentation and time course. The authors are from Leiden University in The Netherlands.
Patient selection: pituitary apoplexy
Pituitary-related symptoms in pituitary apoplexy:
(1) headache
(2) visual field defects
(3) decrease in visual acuity
(4) ophthalmoplegia
Presentation
Onset
Type
acute (< 3 days)
clear and sudden; headaches severe
A
subacute (3 to 21 days)
acute and less acute
B
non-acute (> 2 weeks)
not obvious or sudden; delayed onset of headache
C
The authors also recognized Type D, for a pituitary adenoma without apoplexy. This patient would be at risk for future apoplexy.
Hypopituitarism is manifested by combinations of hypocorticolism, hypothyroidism, hypogonadism, hyposomatotropism, hyperprolactinemia and diabetes insipidus.
Type A patients are seen soon after onset in the Emergency Department and 75% are seen early by neurologists.
Type C patients are usually seen by a primary care provider with only a quarter initially referred to neurology.
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